Cholangiographic Features in the Diagnosisand Management of Obstructive IctericType Hepatocellular Carcinoma

Abstract

In 11 years and 3 months, 2037 patients with HCC were seen and 48 patients (2.4%) were diagnosed to have obstructive icteric type HCC. Five patients were terminally ill and were not investigated further. Forty three patients were initially investigated by endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangiogram (PTC) and classified as having obstructive icteric type 1, 2, or 3 HCC based on the cholangiographic findings. The obstruction in type 1 HCC was due to intraluminal tumour casts and/or tumour fragments obstructing the hepatic ductal confluence or common bile duct, while intraluminal blood clots, from haemobilia, filling the biliary tree was the cause in type 2 HCC. The pathology in type 3 HCC was extraluminal obstruction by extensive tumour encasement of the intra–hepatic biliary ductal system and/or extrinsic compression of the hepatic and common bile ducts by tumour(s) and/or malignant lymph nodes. At the initial ERC/PTC, 10 patients (5 resected, 50%) had obstructive icteric type 1 and 23 patients (0 resected) had obstructive icteric type 3 HCC. Of the 10 patients initially classified according to cholangiography to have obstructive icteric type 2 HCC, subsequent investigations revealed that 6 patients had type 1 HCC (4 resectable, 67%) and 4 patients had type 3 HCC (0 resectable). The classification of the obstructive icteric type HCC into types 1, 2, and 3, based on the initial cholangiographic appearances has simplified and rationalized our management strategy for this condition.

Self-expandable metallic stents vs. plastic stents for endoscopic biliary drainage in hepatocellular carcinoma

“…The type of obstruction was confirmed by direct cholangiography or computed tomography (CT), and was classified as being type 1 (intraluminal obstructions), type 2 (hemobilia), or type 3 (extraluminal obstructions) [3,17]. The location of obstruction was classified as being extrahepatic, hilar, or intrahepatic.…”

Hepatocellular Carcinoma with Obstructive Jaundice: Endoscopic and Percutaneous Biliary Drainage

“…The biliary tumor thrombus gives a cholangiographic intraluminal filling defect that resembles a cork in the neck of a bottle. Lau et al [7] termed this radiologic sign the ‘cork sign’. In patients with intraluminal tumor fragments, the cholangiographic features are similar to those seen in choledocholithiasis but the edges of the filling defects secondary to the tumor fragments are irregular and less well defined than those of stones.…”

Three cases of small hepatocellular carcinoma presenting as obstructive jaundice

“…Obstructive jaundice is uncommon as the initial presenting clinical feature in a patient with hepatocellular carcinoma (HCC). The bile duct can be physically obstructed by HCC in several ways: intraluminal tumour casts or tumour fragments, intraluminal blood clots from haemobilia, extensive tumour encasement of the intrahepatic biliary system, or extrinsic compression of the hepatic and common bile ducts by the tumour or malignant lymph nodes [1]. Lin and colleagues clinically classified such cases as icteric‐type hepatomas [2].…”